Abstract
Background: Herpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection worldwide. This systematic review was conducted to characterize HSV-2 epidemiology in Asia, including the World Health Organization regions of Southeast Asia and the Western Pacific. Methods: Cochrane and PRISMA guidelines were followed to systematically review and report findings. Random-effects meta-analyses and meta-regressions were conducted. Findings: HSV-2 measures extracted from 173 publications included 15 seroconversion rates, 11 seroincidence rates, 272 overall seroprevalence measures (678 stratified), 14 proportions of HSV-2 isolation in genital ulcer disease (GUD) (15 stratified), and 28 proportions of HSV-2 isolation in genital herpes (36 stratified). Pooled mean seroprevalence was 12.1% (95% confidence interval (CI): 11.0-13.2%) among general populations, 23.6% (95% CI: 20.9-26.3%) among men who have sex with men and transgender people, 46.0% (95% CI: 39.2-52.9%) among HIV-positive individuals and individuals in HIV-discordant couples, and 62.2% (95% CI: 58.9-65.6%) among female sex workers. Among general populations, pooled mean seroprevalence increased gradually from 4.7% (95% CI: 3.3-6.3%) in 60-year-old individuals. Compared to women, men had 0.60-fold (95% CI: 54.0-67.0) lower seroprevalence. Seroprevalence declined by 0.98-fold (95% CI: 0.97-0.99) per year in the most recent three decades. Pooled mean proportions of HSV-2 isolation in GUD and in genital herpes were 48.2% (95% CI: 34.9-61.6%) and 75.9% (95% CI: 68.3-82.8%), respectively. Interpretation: Over 1 in 10 individuals is infected with HSV-2, but seroprevalence is declining by 2% per year. HSV-2 accounts for half of GUD cases and three-quarters of genital herpes cases. Funding Statement: This work was supported by the Qatar National Research Fund [NPRP 9-040-3- 008] and by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar. Declaration of Interests: The authors declare no competing interests.
Highlights
Extracted Herpes simplex virus type 2 (HSV-2) measures included 15 seroconversion rates, 11 seroincidence rates, 272 overall seroprevalence measures (678 stratified measures), 14 overall proportions of HSV-2 isolation in genital ulcer disease (GUD) (15 stratified proportions), and 27 overall proportions of HSV-2 isolation in genital herpes (36 stratified proportions)
This study provided a thorough, systematic investigation of HSV-2 epidemiology in Asia
female sex workers (FSWs) had a much higher seroprevalence at 62% than men who have sex with men (MSM) at 23% (Table 1), and women had nearly 70% higher seroprevalence than men (Table 3),[24,39] all affirming women’s higher bio-anatomical susceptibility to this infection,[63,64] and consistent with what is observed in other regions.[24,39]
Summary
Herpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection (STI) worldwide.[1,2] it is usually asymptomatic,[3,4,5] its chronic nature, with persistent reactivations and subclinical shedding, increases its transmission potential, resulting in higher prevalence than other STIs in both the general and higher-risk populations.[6,7,8,9,10]HSV-2 infection manifests in the form of painful, itchy, and often recurrent ulcers in the genital tracts.[3,4,5,11] It can be transmitted vertically from mother to child, causing neonatal herpes, a disease condition associated with high morbidity and mortality.[12,13] HSV-2 infection has been linked to a nearly 3-fold increase in HIV acquisition and transmission,[14,15,16] indicating an epidemiological synergy between the two infections.[17,18,19] Due to the high burden of disease caused by HSV-2, the World Health Organization (WHO) and global partners are leading efforts to develop an HSV-2 vaccine as an urgent priority.[20,21]. Herpes simplex virus type 2 (HSV-2) infection is a prevalent sexually transmitted infection (STI) worldwide.[1,2] it is usually asymptomatic,[3,4,5] its chronic nature, with persistent reactivations and subclinical shedding, increases its transmission potential, resulting in higher prevalence than other STIs in both the general and higher-risk populations.[6,7,8,9,10]. Pooled mean seroprevalence and proportions of HSV-2 isolated in genital ulcer disease (GUD) and in genital herpes were calculated using random-effects meta-analyses. HSV-2 accounts for half of GUD cases and three-quarters of genital herpes cases These findings support the need for an HSV-2 vaccine and universal access to sexual and reproductive health services.
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